Suture for connecting a human or animal tissue, soft anchor and method for attaching a tissue to a bone

ABSTRACT

Described herein is a suture for connecting a human or animal tissue comprising a suture strand, wherein at least two protrusions are provided on the suture strand, the protrusions are provided spaced apart from each other along the suture strand. Also described herein is a soft anchor, the soft anchor having a proximal end and a distal end in an insertion direction. At the proximal end and the distal end the soft anchor includes respectively at least one opening for a suture. The proximal end and the distal end of the soft anchor are connected with at least one, in particular two, connecting portions. The soft anchor has a first state, in which it is adapted to be inserted into a bore in the insertion direction, and a second state, in which it is locked in a bore. In the first state, the distal end and the proximal end defines the extension of the soft anchor in insertion direction.

INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS

Any and all applications for which a foreign or domestic priority claimis identified in the Application Data Sheet as filed with the presentapplication are hereby incorporated by reference under 37 CFR 1.57.

BACKGROUND OF THE INVENTION Field of the Invention

The present application relates to sutures and soft anchors, and methodsfor attaching a tissue to a bone. The present application also relatesto sutures for connecting a human or animal tissue to a bone, and softanchors cooperating with the sutures.

Description of the Related Art

Tears of a soft tissue, for example ligaments or muscles, may berepaired by fixing them to a bone. For example, a torn labrum may beattached again to a glenoid. Various techniques are known, for examplethe usage of rigid, non-flexible anchors for a suture or flexibleanchors for a suture. The ligaments or muscles are fixed using thesuture and the anchor provided in the bone. For example, two suturetails are provided around the tissue and a knot is provided to tie thetwo suture tails together.

SUMMARY OF THE INVENTION

According to one aspect, embodiments relate to a suture for connecting ahuman or animal tissue comprising a suture strand, wherein at least twoprotrusions are provided on the suture strand, the protrusions areprovided spaced apart from each other along the suture strand.

In an embodiment, the protrusions are unidirectional locking devices.The unidirectional locking devices have a first end in a passingdirection, the suture having at the first end a first diametercorresponding substantially to the diameter of the suture strand, and asecond end in a locking direction, the second end protruding in a radialdirection from the circumference of the suture strand and having alocking surface. For example, at the second end, the suture has a seconddiameter being larger than the first diameter at the first end, so thatthe suture may pass through an opening having a diameter between thefirst diameter and the second diameter, but may lock when being moved inthe locking direction. In other embodiments, the second end of theunidirectional locking devices may protrude from the suture strand,and/or may be collapsible to pass through an opening havingsubstantially the same diameter than the suture strand. In such cases,the collapsible unidirectional locking devices may be biased or stressedin a radial direction of the suture strand.

In an embodiment, which may be combined with other embodiments, theprotrusions are braided and/or woven. For example, they may be createdduring manufacture of the suture.

According to a further aspect, embodiments relate to a soft anchor, thesoft anchor having a proximal end and a distal end in an insertiondirection. At the proximal end and the distal end the soft anchorincludes respectively at least one opening for a suture. In anembodiment, the opening(s) is(are) provided such that, in the firststate, a suture may pass through the opening(s) in the insertiondirection. In another embodiment, which may be combined with otherembodiments disclosed herein, the opening(s) at the proximal and distalends are provided such that, in the first state, the suture may passthrough the opening(s) in a direction orthogonal to the insertiondirection.

The proximal end and the distal end of the soft anchor are connectedwith at least one, in particular two, connecting portions. The softanchor has a first state, in which it is adapted to be inserted into abore in the insertion direction, and a second state, in which it may belocked in a bore. In the first state, the distal end and the proximalend define the extension of the soft anchor in insertion direction.

For example, in an embodiment, in the first state the extension of thesoft anchor in an insertion direction is at least two times, inparticular three times the extension of the soft anchor in a seconddirection extending in a plane orthogonal to the insertion direction.

In an embodiment, in the second state, the proximal end and the distalend have approached each other with respect to their distance in thefirst state. For example, the proximal end and the distal end may havein the second state a distance in insertion direction, which is lessthan one half of the distance between them in the first state ininsertion direction, for example less than a third or a quarter of thedistance between them in the first state. In an embodiment, in thesecond state the proximal end and the distal end are close to each otheror may even contact each other.

In an embodiment, when changing from the first state to the secondstate, the at least one connecting portion may be pushed in the seconddirection and/or opposite to the second direction. In the second state,the soft anchor may have a larger extension in the second direction thatin the first state.

In an embodiment, the connecting portion may be a wall. For example, thesoft anchor may have one or two, in particular parallel, connectingportions, such that, in the first state in a cross-section being in aplane of the insertion direction and the second direction, the softanchor has a ring shaped form, in particular a closed ring shaped form.

The soft anchor is, in an embodiment, woven from a suture, for example abiocomposite and/or absorbable suture.

In an embodiment, the opening(s) at the proximal and/or the distal endsare provided to have a diameter being smaller than the second diameterof the suture according to embodiment disclosed herein. For example, thediameter may greater than the first diameter of the suture according toembodiments disclosed herein.

The at least one opening at the proximal end and/or the at least oneopening at the distal end are provided for the suture for fixing thetissue and have reinforced borders. For example a reinforcement braidmay be used for that purpose.

According to another aspect, embodiments relate to a set of partscomprising a suture according to embodiments disclosed herein and a softanchor according to embodiments disclosed herein, wherein the diameterof the opening(s) at the proximal and/or the distal end are provided tohave a diameter being smaller than the second diameter of the suture.

According to a further aspect, the disclosure relates to a method forattaching a tissue to a bone, comprising: providing a suture comprisinga suture strand, wherein at least two protrusions are provided on thesuture strand, the protrusions are provided spaced apart from each otheralong the suture strand; providing a soft anchor having a proximal endand a distal end in an insertion direction, the proximal end and thedistal end the soft anchor including respectively at least one openingfor the suture, wherein the proximal end and the distal end of the softanchor are connected with at least one, in particular two, connectingportions; passing the suture through the opening at the distal and thenthrough the opening at the proximal end; inserting the soft anchorstarting with its distal end into a bore in a bone; and pulling thesuture further through the hole in opposite direction to the insertiondirection while retaining the proximal end of the soft anchor in thesame position.

For example, in the present method, the soft anchor may be according toan embodiment disclosed herein and/or the suture may be according to anembodiment disclosed herein.

In an embodiment, the suture comprises unidirectional locking devicesand is inserted in the passing direction into the soft anchor, so thatthe passing direction is in opposite direction to the insertiondirection.

For example, in an embodiment, during pulling the suture, when the softanchor is in a bore, the soft anchor may deploy from first state to thesecond state.

In some embodiments, a method for securing a suture to a bone isprovided. The method can include inserting a soft anchor into a bore inthe bone. The method can include pulling a suture through at least oneopening in the soft anchor. The suture can include a suture strand andat least two protrusions spaced apart from each other along the suturestrand. Pulling of the suture through the at least one opening can causethe soft anchor to deploy from a first state in which the soft anchor isadapted to be inserted into the bore to a second state in which the softanchor is locked in the bore. The soft anchor can be inserted into thebore in the bone in an insertion direction, and the suture can be pulledthrough at least one opening in the soft anchor in an opposite directionto the insertion direction. The soft anchor can have a proximal end anda distal end, wherein a proximal opening is positioned at the proximalend and a distal opening is positioned at the distal end, and the suturecan be pulled through both the proximal and distal openings. The softanchor can be inserted starting with its distal end into the bore in thebone. The proximal end of the soft anchor can be retained in the sameposition when the suture is pulled through the proximal and distalopenings. The proximal end and the distal end of the soft anchor canapproach each other when transitioning from the first state to thesecond state. The at least two protrusions can comprise unidirectionallocking devices. The method can include passing the suture around apiece of soft tissue prior to pulling the suture through the at leastone opening. The method can include pulling two portions of suturethrough the at least one opening. The two portions of suture can be twoportions of the same suture comprising two groups of unidirectionallocking devices directed in opposite directions. The soft anchor can beinserted into a bore in the glenoid. The direction of inserting the softanchor can be opposite the direction of pulling the suture. The methodcan include the step of decreasing in size a loop configured to surrounda tissue with the passage of each protrusion through the soft anchor.The method wherein the step of deploying to a second state causes thesoft anchor to extend in a plane orthogonal to the direction ofinserting the soft anchor. The method can include the step of attachingthe suture to a torn labrum (or other tissue) to repair the torn labrum(or tissue).

In some embodiments, a suture fixation system is provided. The systemcan include a suture comprising a suture strand and at least twoprotrusions provided on the suture strand. The protrusions can be spacedapart from each other along the suture strand. The system can include asoft anchor. The soft anchor can include a proximal end and a distal endand a connecting portion extending therebetween. The soft anchor caninclude at least one opening disposed at the proximal end, the distalend, or both the proximal and distal ends. The suture can be configuredto pass through the at least one opening in the soft anchor to cause thesoft anchor to deploy from a first insertion state to a second lockingstate. The at least two protrusions can comprise unidirectional lockingdevices. The at least two protrusions can include a first group ofunidirectional locking devices oriented in a first direction and asecond group of unidirectional locking devices oriented in a seconddirection opposite the first direction. The at least two protrusions canhave a braided geometry and can be integrated into the strand. The softanchor can be ring shaped. The soft anchor can be weaved from a suture.The soft anchor can have an opening at the proximal end and an openingat the distal end, and the suture can be configured to pass through bothopenings to cause the openings to approach each other to deploy the softanchor from the first insertion state to the second locking state. Thesystem can include an insertion device configured to deliver the softanchor into a bone and configured to pull the suture through the atleast one opening in the soft anchor. The geometry of the suture cancause the soft anchor to deploy into the second locking state. Thesuture can includes two sections, including a first section ofprotrusions having a first passing direction and a second section ofprotrusions having a second passing direction. The first passingdirection can be opposite the second passing direction. The firstsection and the second section can pass through the soft anchor todeploy the soft anchor to the second locking state.

In some embodiments, a suture fixation system is provided. The systemcan include a suture. The system can include a soft anchor comprising aproximal end comprising an opening, a distal end comprising an openingand a connecting portion extending therebetween. The system can includea bar traversing diametrically at least one of the openings. The systemcan include a first locking element and second locking elements disposedaround the bar. The suture can be configured to pass through the firstlocking element, around the second locking element, and through thefirst locking element to cause the soft anchor to deploy from a firstinsertion state to a second locking state.

In some embodiments, a suture for connecting a human or animal tissue isprovided. The suture includes a suture strand and at least twoprotrusions provided on the suture strand. In some embodiments, theprotrusions are spaced apart from each other along the suture strand.The protrusions may comprise unidirectional locking devices. Theprotrusions may have a fixed relationship to the suture strand andcomprise a leading edge having a first dimension transverse to thestrand and a trailing edge with a second dimension transverse to thestrand, the first dimension being less than the second dimension. Theprotrusions may be collapsible such that the distance that theprotrusions extend from the suture strand is greater in a lockingconfiguration and is less in a passing configuration. The protrusionsmay be braided or woven.

In some embodiments, a soft anchor is provided. The soft anchor includesa proximal end a distal end, and a connecting portion extendingtherebetween. The anchor can be disposed such that the distal end isinserted along an insertion direction prior to the proximal end. Theanchor can include an opening disposed at the proximal end, the distalend, or both the proximal and distal ends. The opening can be configuredto receive a suture. The openings can include a reinforcement braid. Thedimension of the anchor in a direction orthogonal to the insertiondirection is 5 to 10 times the thickness of a wall of the anchor. Theopenings can be configured to receive a suture in the insertiondirection. The openings can be configured to receive a suture in adirection orthogonal to the insertion direction.

The connecting portion can comprises a first body extending between theproximal end and the distal end and a second body extending between theproximal end and the distal end, the first and second bodies beingdisposed laterally of an axis intersecting the proximal and distal endsof the soft anchor. The first and second bodies can comprise walls thatextend along each other in the insertion direction and that are coupledat the proximal and distal ends such that the soft anchor comprises aclosed ring. The soft anchor can comprises a first configuration forinsertion in which a length comprising the distance from the proximalend to the distal end along a first axis intersecting the proximal endand the distal end is greater than a width comprising the distancebetween lateral edges of the soft anchor along a second axisperpendicular to the first axis. The length can be at least two timesthe width. The length can be three times the width. The soft anchorcomprises a second configuration for insertion in which a lengthcomprising the distance from the proximal end to the distal end along afirst axis intersecting the proximal end and the distal end, the lengthin the second configuration being less than the length in the firstconfiguration. The length of the soft anchor in the second configurationcan be no more than ⅓ the length of the soft anchor in the firstconfiguration. The length of the soft anchor in the second configurationcan be no more than ¼ the length of the soft anchor in the firstconfiguration. The proximal end and the distal end can be in contactwith each other in the second configuration. The soft anchor cancomprises a second configuration for insertion in which a widthcomprising the distance between lateral edges of the soft anchor along asecond axis perpendicular to the first axis that is greater than thewidth in the first configuration.

BRIEF DESCRIPTION OF THE DRAWINGS

So the manner in which the above-recited features of the presentinventions can be understood in detail, more particular description ofthe inventions, briefly summarized above, may be made by referencedembodiments. The accompanying drawings relate embodiments of theinvention and are described in the following:

FIG. 1 shows schematically a suture for connecting human or animaltissue according to an embodiment;

FIG. 2 shows schematically another embodiment of a suture for connectinghuman or animal tissue;

FIG. 3 shows a schematically further embodiment of a suture forconnecting human or animal tissue;

FIG. 4 shows schematically an arrangement of protrusions on a suture forconnecting human or animal tissue according to an embodiment;

FIG. 5 shows schematically a soft anchor according to an embodiment;

FIG. 6 shows schematically another embodiment of a soft anchor;

FIG. 7 shows schematically a further embodiment of a soft anchor in afirst state;

FIG. 8 shows schematically the soft anchor of FIG. 7 in a second,deployed state;

FIG. 9 shows schematically an upper or proximal portion of an inserterdevice for inserting the soft anchor;

FIG. 10 shows schematically a cross section of a distal end of theinserter device of FIG. 9;

FIG. 11 shows schematically the soft anchor of FIG. 6 with a sutureprovided therethrough;

FIG. 12 shows the soft anchor of FIG. 11 in a deployed state;

FIG. 13 shows schematically the soft anchor with the suture of FIG. 11provided in a bore in a first state;

FIG. 14 shows the soft anchor of FIG. 13 in a deployed state;

FIGS. 15 to 26 show the different steps of a method for attaching a softtissue to a bone according to an embodiment;

FIG. 27 shows a simplified enlarged view of FIG. 21 using the inserterdevice of FIGS. 9 and 10;

FIGS. 28 and 29 show schematically another embodiment of a soft anchorwith a respective suture in a cinched configuration; and

FIGS. 30 and 31 show schematically a further embodiment of a soft anchorin a first and second state with a respective suture in a cinchedconfiguration.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Reference will now be made in detail to various embodiments, one or moreexamples of which are illustrated in the figures. Each example isprovided by way of explanation, and is not meant as a limitation of theinvention. Within the following description of the drawings, the samereference numbers refer to the same components. Generally, only thedifferences with respect to the individual embodiments are described.

FIG. 1 shows schematically a suture 10 for connecting human or animaltissue. The suture includes a suture strand 12. According to anembodiment, which may be combined with other embodiments disclosedtherein, a plurality of protrusions, for example unidirectional lockingdevices 14, are provided on the suture strand 12. The unidirectionallocking devices 14 may be provided regularly, for example equidistantly,on the suture strand 12. The unidirectional locking devices 14 of thesuture 10 may have a substantially conical shaped geometry. According toan embodiment, the unidirectional locking devices 14 have a braidedgeometry and are integrated into the suture strand 12. Thus, accordingto an embodiment, the suture 10 has a barbed appearance.

The unidirectional locking devices 14 have, according to an embodiment,which may be combined with other embodiments disclosed herein, a firstend 16 in a passing direction P and a second end 18 in a lockingdirection being in opposite direction to the passing direction P. Thepassing direction P is the direction that the suture is moved inrelation to another structure, such as an opening in a tissue or anchor.The suture 10 has at the first end 16 of the unidirectional lockingdevice 14 a first diameter d1, which has substantially the same diameteras the suture strand 12. The suture 10 has at the second end 18 of theunidirectional locking device 14 a second diameter d2 which is largerthan the first diameter d1. At the second end 18, the unidirectionallocking device 14 is provided with a locking surface 19 directedsubstantially to the locking direction. In some embodiments, thetransition from the first diameter d1 to the second diameter d2 issubstantially conical.

The conical geometry makes the suture 10 unidirectional, so that it maypass in the passing direction P through an opening having a diametercorresponding substantially to the diameter of the suture strand 12(e.g., equal to or larger) and having a lower (e.g., smaller) diameterthan the second diameter d2. As discussed further below, the opening canbe disposed in a soft anchor or the wall of another structure. Theunidirectional locking devices 14 are compressible to allow them to passthrough the opening having a diameter smaller than the second diameterd2. Upon passing through the opening, the unidirectional locking devices14 return to their original, uncompressed state. However, the suture 10is locked, when it is pulled in the locking direction (opposite to thedirection P), as a locking surface 19 of one of the unidirectionallocking devices 14 would abut against the wall having or defining theopening. The locking surface 19 prevents the unidirectional lockingdevice 14 of the suture 10 from moving in the locking direction throughthe opening when the suture 10 is pulled or tensioned in the lockingdirection.

FIG. 2 shows another embodiment of a suture 20. The same features aredesignated with the same reference numbers as in FIG. 1 increased by 10.The suture 20 for connecting human or animal tissue includes a suturestrand 22 on which a plurality of protrusions, for exampleunidirectional locking devices 24, are provided. The unidirectionallocking devices 24 have a first end 26 in a passing direction P and asecond end 28 in a locking direction being in opposite direction to thepassing direction P. The suture 20 has at the first end 26 of theunidirectional locking device 24 a first diameter d1, which hassubstantially the same diameter as the suture strand 22. The suture 20has at the second end 28 of the unidirectional locking device 24 asecond diameter d2 which is larger than the first diameter d1. At thesecond end 28, the unidirectional locking device 24 is provided with alocking surface 29. The unidirectional locking devices 24 differ fromthe unidirectional locking devices 14 of FIG. 1 in their geometry. Insome embodiments, the transition from the first diameter d1 to thesecond diameter d2 is substantially curved. For example, theunidirectional locking devices 24 have a more spherical or knottedgeometry (e.g., a curved transition from d1 to d2). However, thefunction is identical to the unidirectional locking devices 14 ofFIG. 1. As in the embodiment of FIG. 1, the unidirectional lockingdevices should assure that the suture 20 only passes in the passingdirection P through an opening of an anchor, which will be explainedfurther below.

FIG. 3 shows a further embodiment of a suture 30 having a plurality ofprotrusions forming unidirectional locking devices 34. The same featuresare designated with the same reference numbers as in FIG. 1 increased by20.

The unidirectional locking devices 34 are arrow shaped and have asemi-collapsible end. In particular, the unidirectional locking devices34 have a first end 36 in a passing direction P and a second end 38 in alocking direction, wherein at the first end 36 the suture 30 hasapproximately the first diameter d1 of the suture strand 32. The secondend 38 protrudes from the suture strand 32 so that the suture 30 has atthe second end 38 a width of d2 which is greater than d1 based on thenumber of unidirectional locking devices at a specific point of thesuture, and the distance b between the second ends 38 and the perimeterof the suture strand 32. For example, if two locking devices aredisposed at the specific point and are on opposite sides of the suture,the width of the suture will be d1+2×b. The distance b is the distancethe second end 38 protrudes from the perimeter of the suture strand 32.At the second end 38, the unidirectional locking device 34 is providedwith a locking surface 39. When cooperating with an opening having adiameter between the first diameter d1 of the suture 30 and seconddiameter d2 (e.g., a diameter greater than d1 and less than d2), thesuture 30 may only pass in the passing direction P through said opening.In some embodiments, the transition from the first diameter d1 to thesecond diameter d2 is substantially curved, wedged or arrow-shaped. Theunidirectional locking devices 34 have a semi-collapsible, second end38, so that they form a barbed structure.

In other embodiments, which may be combined with the embodimentdisclosed herein, other geometries may be used to provide theunidirectional locking device, so that a barbed or locking effect iscreated like in the embodiments of FIGS. 1 to 3.

In further embodiments, the protrusions, e.g., unidirectional lockingdevices, provided on the suture strand may have a diamond-shapedgeometry. In contrast to the conical shaped geometry, which isunidirectional and explained with respect to FIG. 1, the diamond-shapedgeometry of the protrusions may be used to allow for multi-directionalsuture passing through an opening, when being pulled with a certainforce.

In some embodiments, different types and geometries of protrusions maybe combined on a suture (e.g., unidirectional locking devices,multi-directional locking devices). In other embodiments, the number andspacing of the protrusions may vary.

In an embodiment, the protrusions, e.g., unidirectional locking devices,are formed, in particular, braided and/or knotted, during the weavingprocess of the suture strand or after the sutures are woven or otherwisemanufactured. For example they are integrated into the suture strand.Thus, they may be made of the same material as the suture strand. Inother embodiments, the unidirectional locking devices or otherprotrusions may be also over-molded, for example injection molded onto asuture strand. The molded protrusions may be molded of a PEEK (polyetherether ketone) or other bioabsorbable materials, for example P4HB(Poly-4-hydroxybutyrate) or PLA (Poly lactic acid) or a combinationthereof, or other materials, for example bioabsorbable p4hb5Poly-4-hydroxybutyrate) or bioabsorbable PLA (Poly lactic acid) or acombination thereof.

In an embodiment, which may be combined with other embodiments herein,the suture, in particular the suture strand, may be produced on or frompermanent or absorbable fiber. For example, a permanent fiber may be apolyethylene fiber. For example, an absorbable fiber may be fabricatedfrom a resorbable polymer, for example P4HB (Poly-4-hydroxybutyrate) orPLA (Poly lactic acid), or a combination thereof.

FIG. 4 shows schematically a further embodiment of a suture 40. Thesuture 40 includes a suture strand 42 on which a plurality ofprotrusions, for example, unidirectional locking devices 44, 46, arearranged. The unidirectional locking devices 44, 46 may be aunidirectional locking device according to an embodiment disclosedherein, for example one of the locking devices shown in FIGS. 1 to 3.

The suture 40 includes two adjacent sections, namely a first section 48having a first passing direction P1 and a second section 50 having asecond passing direction P2 being, along the suture, in an oppositedirection to the first passing direction P1. The first passing directionP1 of the first section 48 is provided by a first group ofunidirectional locking devices 44 and the second passing direction P2 isprovided by a second group of unidirectional locking devices 46. Theunidirectional locking devices of each group are arranged on arespective section 48, 50 of the suture strand 42. Both sections 48, 50are arranged, such that the suture 42 has a point 52 from which thefirst and second passing directions P1, P2 move away. In someembodiments, the point 52 and the suture 42 near the point 52 form aloop around soft tissue, as shown in FIGS. 23-26.

FIGS. 5 to 8 show schematically different soft anchors.

FIG. 5 shows schematically an embodiment of a soft anchor 60 in a firststate. The anchor 60 has a first state, in which the anchor 60 isadapted to be inserted into a bore in the insertion direction X, and asecond state, in which it is locked in a bore. In the first state, theanchor 60 has an elongated form in the insertion direction X. In theinsertion direction X, the anchor 60 has a proximal end 62 and distalend 64. In the first state, the distal end 64 and the proximal end 62define the extension of the anchor 60 in the insertion direction X. Atthe proximal end 62 and the opposite distal end 64, the anchor comprisesrespectively at least one opening 66, 68 adapted for receiving a sutureaccording to an embodiment disclosed herein. In other embodiments, theanchor 60 may comprise respectively two, three, or more openings at theproximal end 62 and/or the distal end 64 of the anchor 60.

In an embodiment, which may be combined with another embodimentdisclosed herein, the borders of the openings 66, 68 are reinforced forbetter retaining the sutures, such as sutures comprising theunidirectional locking devices. For example, the openings can bereinforced by providing a reinforcement braid 70, 72 around the openings66, 68. In some embodiments, the borders of the openings 66, 68 arereversibly stretchable larger, e.g., can stretched to a wider dimensionthen return toward a narrower dimension. In some embodiments, theprotrusions, in particular the the unidirectional locking devices arereversibly compressible, for example as shown in the embodiment of FIGS.1-3, in order for the protrusions to pass through the openings 66, 68and subsequently lock, in case of the unidirectional locking devices,the suture to the anchor 60.

The proximal end 62 and the distal end 64 are connected by two walls 74,76 forming connecting portions. In some embodiments, the two walls 74,76 are flat walls. The walls 74, 76 are arranged substantially parallelin the first state of the anchor 60. In particular, the walls 74, 76 arespaced apart in a second direction Z being orthogonal to the insertiondirection X. The walls 74, 76 extend in a plane defined by the insertiondirection X and a third direction Y, the third direction Y beingorthogonal to the insertion direction X and orthogonal to the seconddirection Z. For example, in an embodiment, the walls 74, 76 have alarger extension in the insertion direction X than into the thirddirection Y. For example, the extension of the walls 74, 76 in the thirddirection Y is at least 5 times the thickness dw of the wall, inparticular at least 10 times dw. The anchor 60 has into the thirddirection Y a larger extension than into the second direction Z, so thatthe anchor 60 has a flat body in the first state.

In some embodiments, the anchor 60 has a ring shaped geometry in a planedefined by the insertion direction X and the second direction Z. Forexample, the extension into the insertion direction X is, in the firststate, at least two times the extension into the second direction Z, forexample about three to four times the extension into the seconddirection Z.

The anchor 60 can be collapsed from the first state shown in FIG. 5 to asecond state (not shown) in a controlled way, such that walls 74, 76connecting in parallel the proximal end 62 with the distal end 64 arepushed into opposite directions in the second direction Z. Thus, theextension in the second direction Z in the second state is larger thanthe extension in the second direction Z in the first state. Inparticular, the anchor 60 is forced into the second state by approachingthe first opening 66 at the proximal end 62 toward the second opening 68at the distal end 64. For example, the suture described with respect toFIGS. 1 to 4 may be used to transition the anchor 60 from the firststate to the second state, as described herein.

According to an embodiment, which may be combined with other embodimentsdisclosed herein, the anchor 60 is knotless and can be woven from asuture. Thus, the anchor is not rigid, but is soft. In some embodiments,the soft anchor body is a single piece woven construction.

The suture for weaving the anchor body 60 may be a permanent orabsorbable suture according to an embodiment, which may be combined withother embodiments herein. For example, a permanent suture may be apolyethylene suture, e.g. Ultra-high-molecular-weight polyethylene(UHMWPE). For example, an absorbable suture may be fabricated from aresorbable polymer, for example P4HB (Poly-4-hydroxybutyrate).

In an embodiment, a suture for connecting a tissue to a bone is passingthrough the openings 66, 68 at the proximal and distal ends 62, 64 andwould be arranged in the space between the first wall 74 and the secondwall 76.

In another embodiment, which may be combined with the embodimentsdisclosed herein, the walls 74, 76 connecting the proximal end 62 withthe distal end 64 are hollow. In other words, the walls 74, 76 maycomprise two layers, namely an inner layer 78 and an outer layer 80.

For example, in an embodiment, the openings 66, 68 at proximal end 62and the distal end 64 are only provided in the outer layer 80. The outerlayer 80 does not provide access to the space between the first wall 74and the second wall 76. Thus, strands or sutures passing through theanchor 60 may pass through the walls 74, 76 between the inner layer 78and the outer layer 80 before reaching the openings 66, 68 at theopposite end of the anchor 60. In other words, the ring shaped anchorbody could be hollow on the inside turning it into a sheath that asuture, for example the suture with protrusions according to anembodiment disclosed herein, would pass through.

FIG. 6 shows another embodiment of a soft anchor 90. The soft anchor ofFIG. 6 may comprise some of the features of the embodiment of FIG. 5,for example, the materials and the reinforcements at the border of theopenings.

The anchor 90 has an elongated shape in inserting direction X in a firststate shown in FIG. 6. The anchor 90 has a proximal end 92 and a distalend 94 which is connected in parallel by two connecting portions 96, 98.In the embodiment of FIG. 6, the anchor 90 is provided by a body havinga round section forming a loop. The anchor body is woven according to anembodiment. At least one opening 100, 102 is provided respectively atthe proximal end 92 and the distal end 94.

The extension of the connecting portions 96, 98 in a second direction Zbeing orthogonal to the insertion direction in X is substantially equalto the extension of the anchor in a third direction Y, the thirddirection Y being orthogonal to the insertion direction X and orthogonalto the second direction Z.

The anchor 60 of FIG. 6 is shown in the first state in which theextension in the insertion direction X is greater than the extension inthe second direction Z. For example, in the present example, theextension in the insertion direction X is at least two times theextension in the second direction Z.

The second state of the anchor shown in FIG. 6 will be explained withrespect to FIGS. 12 and 14 here below.

FIGS. 7 and 8 show a further embodiment of a soft anchor 110. FIG. 7shows the anchor 110 in a first state and FIG. 8 shows the anchor 110 ina second, deployed state. The anchor 110 has an elongated shape in theinsertion direction X in a first state shown in FIG. 7. In someembodiments, the elongated shape is substantially cylindrical.

The anchor 110 has a proximal end 112 and distal end 114. In someembodiments, the proximal end 112 and the distal end 114 are flat andsubstantially disc shaped. In the embodiment shown in FIGS. 7 and 8, theproximal end 112 and distal end 114 have surfaces with substantiallycircular perimeters. In other embodiments, the proximal and distal ends112, 114 may have another form, for example they may have a perimeterwith an oval, rectangular or have a polygonal form.

The proximal and the distal ends 112, 114 include respectively anopening 116, 118. In some embodiments, the proximal end 112 and/or thedistal end 114 may include two, three, or more openings. A wall 120connects the proximal end 112 with the distal end 114. In someembodiments, the extension of the wall 120 in a second direction Z beingorthogonal to the insertion direction in X is substantially equal to theextension of the anchor in a third direction Y, the third direction Ybeing orthogonal to the insertion direction X and orthogonal to thesecond direction Z. The wall 120 can have a circular outer perimeter inthe Y-Z plane.

In some embodiments, the anchor 110 has a cross-section that issubstantial circular in a plane orthogonal to the insertion direction X.In other embodiments, where the proximal end 112 and the distal end 114have another shape, for example if the ends 112, 114 are oval,rectangular, or in a polygonal form, the wall 120 forms a connectorportion between the proximal end 112 and the distal end 114, and hasalso the respective form. In other words, in the first state, the anchor110 forms an enclosed shaped, such as a hollow cylinder in the generalmeaning of cylinder and is not limited to a circular cylinder.

The anchor 110 may collapse into the second state, shown in FIG. 8,where the proximal end 112 and the distal end 114 are moved toward eachother, and in some embodiments, may abut each other. The wall 120 isthen pushed into a radial direction so that the diameter in the seconddirection Z and the third direction Y is substantially increased withrespect to the first state.

For example, if the anchor 110 is inserted in the inserting direction Xin the first state into a bore having a diameter corresponding to thediameter of the proximal end 112 or the distal end 114, and thensubsequently manipulated to assume the form of the second state. As canbe seen from FIG. 8, in the second state the diameter of the anchor 110in a plane orthogonal to the insertion direction X, or a seconddirection Z orthogonal to the insertion direction X, has increased dueto the wall 120 which has been pushed in several radial directions.Thus, the anchor 110 is not able to pass through the bore again. Inother words, the anchor 110 is collapsed in FIG. 8 to prevent removal ofthe anchor 110 from the bore.

In the embodiment of FIGS. 7 and 8, a suture passing through theopenings 116, 118 would go through the center of the enclosed spacedefined by the wall 120, which in some embodiments is generally tubularor cylindrical.

Other geometries could be used for the soft anchors. The shape of thebody of the soft anchor according to embodiments of this inventionallows for controlled collapse and superior pull-out strength, inparticular when inserted into a bore.

In an embodiment, which may be combined with other embodiments disclosedherein, the soft anchors 60, 90, 110 may in the second state collapse inmultiple axes, in other words, the walls may extend in a planeorthogonal to the insertion direction X in multiple directions.

FIG. 9 shows an insertion or inserter device 130 for usage with the softanchors and the sutures according to embodiments disclosed herein. Theinsertion device 130 has a hollow tube 135 at its distal end throughwhich at least one suture 140, for example two or more sutures may pass.The insertion device 130 includes a handle 134 at the proximal end formanipulating the insertion device 130. The handle 134 has an opening 136through which the sutures 140 may pass to be able to be pulled, asindicated by the arrow A1, and a second passage orthogonal to theopening 136 through which the suture 140 may pass or be able to bepulled, as indicated by the arrow A2.

FIG. 10 shows the distal end 132 of the insertion device 130 in asimplified enlarged cross-sectional view. The distal end 132 comprises acannulated tube 135 in which a shaft 137 is arranged. The shaft 137 canbe solid and comprises a shaped portion 138 at its distal end for movingthe distal end of a soft anchor into a bore of a bone. In someembodiments, the shaped portion can be forked, pointed or any othershape. The shaft 137 is independently movable in longitudinal directionof the insertion device 130 with respect to the tube 135. As shown inFIG. 9, one or more sutures 140, or the ends of the same suture, may bepassed through the tube 135. The unidirectional locking devices of thesutures are oriented within the insertion device 130 so that movement inthe direction A causes the unidirectional locking devices to passthrough the anchors in passing direction P. The shaft 137 has twopositions, namely an extended position, in which the shaft 137 extendsout of the tube 135, and a retracted position, in which the shaft 137and in particular the shaped portion 138 is retracted into the tube 135.

FIGS. 11 to 14 show how the suture 140 comprising the unidirectionallocking devices 14 cooperates with a soft anchor according to anembodiment disclosed herein. The suture 140 has at the first end 146 ofthe unidirectional locking device 144 a first diameter d1, which hassubstantially the same diameter as the suture strand 142. The suture 140has at the second end 148 of the unidirectional locking device 144 asecond diameter d2 which is larger than the first diameter d1. At thesecond end 148, the unidirectional locking device 144 is provided with alocking surface 149. The unidirectional locking device 144 can havesimilar features to 14, 24, 34, 44, 46 of embodiments shown in FIGS.1-4. FIGS. 11 to 14 show the usage of the anchor 90 according to FIG. 6.However, also other anchors, such as anchors 60, 110, according toembodiments disclosed herein may be used.

In FIG. 11, the anchor 90 is in the first state and in FIG. 12, theanchor 90 is in the second state. In FIG. 11, the unidirectional lockingdevice 144 on the suture 140 has not made an initial contact with theanchor 90. The suture 140 is passed through the openings 100, 102 at theproximal and distal end 92, 94 of the anchor 90 in the passing directionP. In some embodiments, the passing direction P is in opposite directionto the insertion direction X. The diameter of the openings 100, 102 issized between the first diameter d1 and the second diameter d2 of thesuture 140 (e.g., a diameter greater than d1 and less than d2),preferably close to the first diameter d1. Although FIGS. 11-14illustrate a single suture 140 passing through the openings 100, 102 ofthe anchor 90, multiple sutures or portions of the same suture may alsopass through the openings 100, 102. In some embodiments, theunidirectional locking devices of multiple sutures or portion of thesame suture are oriented so that the passing direction P is the same forall sutures when passed through the openings 100, 102.

In some embodiments, the suture 140 or sutures may pass through theopenings 100, 102 in the anchor 90 and pass through the tube 135 towardopening 136 of the insertion device 130, as shown in FIG. 9, to load thesuture(s) 140 into the insertion device 130. In some embodiments, theanchor 90 is loaded into the insertion device 130 when the anchor 90 isin the first state. While the anchor is maintained in the first state,the anchor 90 with the suture 140 may be inserted into a bore 150 of abone 152 as shown in FIG. 13. For example, with the suture 140 orsutures passing through the openings 100, 102 in the anchor 90, theanchor 90 may be inserted with the distal end 132 of the inserter device130, shown in FIG. 10. The distal end 138 of the shaft 137 engages theanchor 90 such that the anchor 90 is pushed down to the distal end ofthe bore 150 in the insertion direction X. In some embodiments, theshaft 137 of the insertion device 130 engages the inner side of thedistal end 94 of the anchor 90 (not shown). In some methods, the shaft137 of the inserter device 130 is moved in proximal direction to retractthe shaft 137 into the tube 135. The distal end of the tube 135 rests incontact with the proximal end 92 of the anchor 90, as shown in FIG. 13.In a step, the suture 140 is pulled in the passing direction P, so thata unidirectional locking device 144 engages or comes into contact withthe distal end 94 of the anchor 90 (see for example FIG. 13). In FIG.13, the unidirectional locking device 144 has not passed throughopenings 100, 102. Then, in a further step, the suture 140 is furtherpulled in the passing direction P, whereas the proximal end 92 of thesoft anchor 90 is held in place, for example by the distal end of thetube 135 of the insertion device 130.

Upon further pulling of the suture 140 in the passing direction P, theconnecting portions 96, 98 of the anchor 90 start to deploy in a planeorthogonal to the insertion direction X, for example in the seconddirection Z and/or in the third direction Y. In other words, the suture140 is pulled and the unidirectional locking device 144 comes intocontact with the distal end 94 of the anchor 90 and then begins to pullthe distal end 94 of the anchor 90 up proximally. The unidirectionallocking devices 144 will urge the anchor 90 in the passing direction Pbefore passing through the opening 102. The unidirectional lockingdevices 144 will compress as they pass through opening 102 if suchcompression requires less force than expansion of the anchor 90. As thedistal end 94 of the anchor 90 is pulled up proximally, the body of theanchor begins to expand as shown in FIG. 12. As shown in FIG. 14, thesuture 140 may comprise a plurality of unidirectional locking devices144. When the unidirectional locking devices 144 pass through theopening 100, the anchor 90 will compress (e.g., become smaller) in theinsertion direction X and may expand (e.g., become larger) in the seconddirection Z and/or the third direction Y.

Then, the suture 140 is further pulled, such that a unidirectionallocking device 144 passes both the opening 102 in the distal end 94 andopening 100 the proximal end 92 of the anchor 90 as shown in FIG. 14. Inthis configuration, the anchor 90 is deployed or in the second state,and the suture 140 cannot pass backward in the insertion direction orlocking direction through the anchor 90 because a locking surface 149 ofthe unidirectional locking device 144 prevents movement. In someembodiments, the unidirectional locking devices 144 have passed theopening 100 in the proximal end 92 and the locking surface 149 abutsagainst the proximal end 92 of the anchor 90. In some embodiments, theunidirectional locking devices 144 has passed the opening 102 in thedistal end 94 and the locking surface 149 abuts against the innersurface of the distal end 94 of the anchor 90. The openings 100, 102 ofthe anchor 90 are adapted to let pass the suture 140 including theunidirectional locking devices 144 only in one direction. The suture 140is able to be pulled through the anchor 90 in one direction (e.g., thepassing direction P), but it cannot be pulled through the oppositedirection.

In other words, as the suture 140 with the unidirectional lockingdevices 144, for example having the knotted, barbed or woven lockinggeometry described herein, is pulled through the anchor 90 it begins tolock itself on the proximal side of the anchor 90. Each time aunidirectional locking device 144 of the suture 140 is pulled throughthe proximal end 92 of the anchor 90, the locking surface 149 locksitself in that position and the anchor 90 holds tension on a softtissue, which was fixed with the suture 140. The unidirectional lockingdevices 144 on the suture 140 lock the suture 140 in place. The anchor90 coupled to the suture 140 can be compressed against soft tissuethereby retaining the anchor 90 in the bore 170 by friction fit. Or, insome embodiments the anchor 90, as it expands radially, may crush thecancellous bone that it comes into contact with, as shown in FIG. 14.

Thus, the anchor 90 is fixed in the bone 152 without being able to bepulled out of the bore 150. FIG. 14 shows the anchor 90 in one collapsedstate, for example, a collapsed state without external constraints fromthe bone 152 (e.g., displacing or compressing the bone that the anchor90 contacts). In some embodiments, the anchor 90 may cause lessdeformation of the bone 152 (e.g., slight deformation). In someembodiments, the anchor 90 causes no deformation of the bone 152 andrather abuts the surface of the bore 150 causing a frictional fitbetween the anchor 90 and the bore 150. The ends of the suture 140extending form the bore 150 can be coupled to another structure, such assoft tissue (not shown).

According to another embodiment, multiple sutures, for example twosutures 140, are intended to be pulled through the anchor 90.

In other words, the geometry of the suture 140 causes the anchor 90 todeploy or collapse and lock into a closed position or second state andhold tension on the suture 140.

FIGS. 15 to 26 show several steps for proceeding to repair of a torntissue, for example a torn labrum.

In steps of a method, shown in FIGS. 15 and 16, a suture 160 is passedaround a piece of a soft tissue 162, for example a labrum. The bone 168is also shown.

After the suture has been passed around the soft tissue 162, as shown inFIG. 16, both tails 164 of the suture 160 are passed through theopenings 100, 102 at the distal and proximal ends 92, 94 of the anchor90. For example, the anchor 90 according to FIG. 6 is shown in FIG. 17,but other anchors described herein may be used. In FIG. 17, the anchor90 is already attached to the insertion device 130 in its first stateprior to passing the tails 164 through the openings 100, 102. Forexample, the tube 135, in particular the distal end of the tube 135, isadapted to come in contact with the proximal end 92 of the anchor 90.The shaft 137 extends out of the tube 135 and come in contact with thedistal end 94 of the anchor 90. For example, the distal end 94 of theanchor 90 is engaged by the shaped portion 138 of the shaft 137, asshown in FIG. 17.

A hole is drilled into the bone 168, for example a glenoid, to form abore 170. As shown in FIGS. 18 and 19, the anchor 90 is inserted in thebore 170 using the insertion device 130. In an embodiment shown in FIG.20, a mallet 171 may be used to fully insert in the anchor 90 into thebore 170, as shown by the downward arrows. This may be determined byabutting the insertion device 130 on the bone 168. The user can hold ahandle 173 of an inserter shaft 172 while using the mallet 171.

FIG. 21 shows a section through the bone 168 and the insertion device130 and the bore 170. The insertion device 130 comprising the suture160, the tube 135 and the shaft 137 can pass through the handle 173. Thesuture 160 is passed around the soft tissue 162. The suture 160 ispassed through the insertion device 130 such the tails of the suture 160pass in the same direction, passing direction P, through the anchor 90from the distal end 94 toward the proximal end 92.

FIG. 27 shows a simplified enlarged view of FIG. 21 without the suture160. The tube 135 and optionally the distal end 138 of the shaft 137 ofthe insertion device 130 holds the anchor 90 in place while it is in thebore 170. The shaft 137 is already pulled back through the anchor 90into the tube 135 for the deployment of the anchor 90. As it can be seenfrom FIGS. 21 and 27, the anchor 90 is inserted into the bore 170 whilein its first state. Referring to FIGS. 21 and 27, when the suture 160 ispulled, the anchor 90 stays in place due to the tube 135 of theinsertion device 130, the tip 138 of the shaft 137 and/or the tip 174 ofthe inserter shaft 172.

In some methods, shown in FIG. 22, the suture tails or strands 164 ofthe suture 160 are pulled and begin to progress through the anchor 90.The suture can be pulled while the tube 135 holds the proximal end 92 ofthe anchor 90 in place, as shown in FIG. 27. In some methods, the handle134 is coupled to the suture 160 and pulled in the passing direction P.Referring back to FIG. 9, the suture 160 may pass through opening 136 inthe insertion device 130. A cap 163 can secure the suture to the handle134, such that upward movement of the handle causes the suture 160 topass in the passing direction P. In some methods, only the suture 160 ispulled and the handle 134 remains stationary.

In FIG. 23 the suture 160 is shown in more detail. In the present case,the suture 160 comprises unidirectional locking devices 180, 182according to an embodiment disclosed herein. The suture 160 has twogroups of unidirectional locking devices, being directed in oppositedirections as shown in FIGS. 4 and 23, and defining respectively asection of the suture 160. In other words, the suture 160 includes twosections, namely a first section with unidirectional locking devices 180having a first passing direction P1 and a second section unidirectionallocking devices 182 having a second passing direction P2, as shown inFIG. 23. In some techniques, a section of the suture 160 between thefirst second and the second section forms a loop around soft tissue 162.In some techniques, as shown in FIGS. 15-16, the suture 160 is loopedaround the soft tissue 162 before engaging the anchor 90.

The suture 160 has a loop 178, which is arranged around the soft tissue162, in this case the labrum, which should be fixed to the bone 168. Thesuture 160 comprises a plurality of unidirectional locking devices 180,182 comprising a first group of unidirectional locking devices 180defining a first section and a second group of unidirectional lockingdevices 182 defining a second section. The first and the second sectionsof the suture 160 have opposite passing directions P1, P2, as explainedalready with respect to FIG. 4 and above. The unidirectional lockingdevices 180, 182 can have similar features to 14, 24, 34, 44, 46 ofembodiments shown in FIGS. 1-4. For example, the unidirectional lockingdevices 180, 182 may have a woven conical geometry, as shown in FIG. 1.Both sections of the suture 160 pass in the same direction, passingdirection P, through the anchor 90, namely from the distal end 94 to theproximal end 92 of the anchor 90. The unidirectional locking devices180, 182 pass through the anchor 90 and the anchor 90 begins to compressand to extend in a plane orthogonal to the insertion direction X as itis shown in FIGS. 11 to 14. The anchor 90 transitions from the firststate to the second state by the same method as described with respectto FIGS. 11-14. The suture 160 is tensioned around the soft tissue 162as needed by passing the suture 160 through the anchor 90.

FIG. 24 shows the fully compressed anchor 90 locked into the bore 170 inthe bone 168. In other words, as the suture 160 progresses through theanchor 90, the anchor 90 expands and locks itself to the bore 170. Eachtime the unidirectional locking devices 180, 182 pass through the anchor90, the loop 178 around the soft tissue 162 decreases in size and pullstighter on the soft tissue 162. The tension on the soft tissue 162 islocked in place due to the unidirectional locking devices 180, 182 onthe suture 160. The tube 135 of the inserter 130 is removed from thebore after the anchor 90 is deployed and sutures 160 are in place.

FIG. 25 shows the sutures 160 tensioned around the soft tissue 162. Insome embodiments, excess suture 160, such as the suture tails 164 shownin FIG. 24, are cut. In some embodiments, it is not necessary to knotboth tails 164 of the suture 160 together to fix the soft tissue 162 tothe bone 168 due to the unidirectional locking devices 180, 182.

The method for attaching a soft tissue 162 to a bone 168 can be repeatedat several times to fix several locations of the soft tissue 162 asshown in FIG. 26, where a completed repair is shown.

In some embodiments, the anchor 90 may be preloaded with a suture foruse in a standard tip (e.g., non cinchable) suture configuration. Inother embodiments, as shown in FIGS. 15 to 26, the suture 160 is passedthrough the anchor 90 after it has been passed through a soft tissue 162to be fixed to a bone.

FIGS. 28 and 29 show a further embodiment of an anchor 260 that may beused with a suture 280 according to an embodiment disclosed herein. Theanchor 260 is shown in the second state. The suture 280 can include theunidirectional locking device 288. The unidirectional locking device 288can have similar features to 14, 24, 34, 44, 46 of embodiments shown inFIGS. 1-4.

In some embodiments, a single piece anchor design could be altered toinclude multiple loop features that would allow for cinchability.

The anchor 260 corresponds substantially to the soft anchor 60 shown inFIG. 5. In some embodiments, the anchor 260 is knotless and woven from asuture. The anchor 260 has a proximal end 262 and a distal end 264. Theproximal end 262 and distal end 264 are connected by two walls 266, 268.In the first state, the walls 266, 268 are arranged substantiallyparallel to each other, similar to walls 76, 78 shown in FIG. 5. Incontrast to the embodiment shown in FIG. 5, in a section of the proximalend 262, at which the proximal end 262 merges with the two walls 266,268, the anchor 260 comprises respectively two openings 270 opposingeach other. In a section of the distal end 264, at which the distal end264 merges with the two walls 266, 268, the anchor 260 comprisesrespectively two openings 272 opposing each other. In some embodiment,the anchor 260 may comprise more than respectively two opposite openings270, 272.

The anchor 260 may be used with a suture 280 in several ways, two ofthem are shown in FIGS. 28 and 29.

The suture 280 may be, for example, similar to the suture 160 shown inthe previous example. For example, the suture may comprise two sectionshaving opposite passing directions P1 and P1, respectively in directionof the suture tails 282, 284. The suture 280 is provided in a loop 286around a soft tissue. Both tails 282, 284 are then inserted firstthrough both openings 272 at the distal end 264 and then, subsequentlyon the same side through both openings 270 at the proximal end 262, sothat the suture passes in outside of the anchor 260 along one of the twowalls, here the wall 268. When the tails 282, 284 of the suture 280 arepulled, both of the walls 266, 268 are folded. For example, the wall 268is folded so that a proximal end 262 of the wall may abut a distal end264 of the wall 268. The unidirectional locking devices 288 pass throughthe openings 272 at the distal end 264 and subsequently through theopenings 270 at the proximal end 262. The unidirectional locking devices288 pass through the openings 270, 272 and lock at one of the openings270 at the proximal end 262 when the locking surface of theunidirectional locking devices 288 abuts the wall 266. In particular,the openings 272 of the distal end 264 are close to the openings 270 ofthe proximal end 262 of the anchor 260 when the suture 260 is tensionedthereby tensioning, the soft tissue in the loop 286.

FIG. 29 shows a different arrangement of the suture 280. The suturetails 282, 284 are first inserted through the openings 270 at theproximal end 262 in a first insertion direction ID. Then, the tails 282,284 are passed around the distal end 264 anchor 260 toward openings 272.Subsequently, the tails 282, 284 are inserted at the distal end 264through both opposing openings 272, and reinserted through the opposingopenings 270 at the proximal end 262 in an opposite direction to theinsertion direction ID. The unidirectional locking devices 288 passthrough the openings 270, 272 and lock at one of the openings 270 at theproximal end 262 when the locking surface of the unidirectional lockingdevices 288 abuts the wall 266. In particular, the openings 272 of thedistal end 264 are close to the openings 270 of the proximal end 262 ofthe anchor 260 when the suture 260 is tensioned, thereby tensioning thesoft tissue in the loop 286.

FIGS. 30 and 31 show further embodiments of an anchor 290. The anchor290 can be similar to anchor 110 of FIGS. 7 and 8. In FIG. 30 the anchor290 is shown in the first state. The same reference numbers refer to thesame features as in FIGS. 7 and 8. The proximal end 112 includes theopening 116 and the distal end 114 includes the opening 118. The wall120 connects the proximal end 112 with the distal end 114.

The embodiment of the soft anchor 290 of FIGS. 30 and 31 furthercomprises a bar 292 traversing diametrically the opening 118 at thedistal end 114, spanning the inner surface of the wall 120. The bar 292is provided to hold two soft suture rings 294, 296. The soft suturerings 294, 296 can be configured substantially similar to anchorsdescribed herein. The rings 294, 296 encircle the bar 292. The rings294, 296 are not otherwise connected to the bar 262 allowing forlongitudinal movement in the insertion direction X. In some embodiments,the rings 294, 296 have substantially the same diameter, extensionand/or circumferential lengths.

FIG. 31 shows the soft anchor 290 in the second state. A suture 300 isthreaded in a manner similar to FIG. 29. The suture 300 can have similarfeatures to sutures described herein or can have a smooth outer surfacewithout locking devices. The tails 382, 384 of a suture 300 are firstpassed through the first ring 294 in a first insertion direction ID.Then the tails 382, 384 are then passed around and through the secondring 296. Subsequently, the tails 382, 384 are then passed in thereverse direction opposing the first insertion direction ID through thefirst ring 294. Finally, both tails 382, 384 of the suture 300 arepulled, and the anchor 290 starts to collapse to reach the second state.In some embodiments, the suture 300 is held in place by the internalfriction of between the suture 300 and the rings 294, 296. In otherembodiment, one or more of the rings 294, 296 have openings 100, 102similar to FIG. 11. The suture 300 can include unidirectional lockingdevices (not shown). The rings 294, 296 transition from the first stateto the second state by the same method as described with respect toFIGS. 11-14. Thus, the anchor 290 is cinched. Thus, according to theinvention a knotless suture fixation is shown. Such a knotlessconfiguration will allow the soft anchor to be used in multipleindications.

Various modifications and additions can be made to the exemplaryembodiments discussed without departing from the scope of the presentinvention. For example, while the embodiments described above refer toparticular features, the scope of this invention also includesembodiments having different combinations of features and embodimentsthat do not include all of the described features. Accordingly, thescope of the present invention is intended to embrace all suchalternatives, modifications, and variations as fall within the scope ofthe claims, together with all equivalents thereof.

While embodiments of this invention have been particularly shown anddescribed with references to embodiments thereof, it will be understoodby those skilled in the art that various changes in form and details maybe made therein without departing from the scope of the invention. Forall of the embodiments described above, the steps of the methods neednot be performed sequentially.

What is claimed is:
 1. A method, comprising: positioning a soft anchor,the soft anchor comprising: a body comprising a proximal end comprisingan opening, a distal end, and a connecting portion extendingtherebetween; and a first locking element coupled to the body and asecond locking element coupled to the body, wherein the first lockingelement and the second locking element are coupled to a bar, wherein thebar is coupled to the body; and pulling a suture to cause the softanchor to compress from a first insertion state to a second lockingstate, the suture passed through the first locking element, around thesecond locking element, and through the first locking element.
 2. Themethod of claim 1, wherein the bar traverses diametrically the body,wherein the first locking element and the second locking element aredisposed around the bar.
 3. The method of claim 1, further comprisinginserting the soft anchor into a bore in a bone.
 4. The method of claim3, further comprising locking the soft anchor in the bore.
 5. The methodof claim 1, further comprising moving the first locking element in alongitudinal direction.
 6. The method of claim 1, wherein pulling thesuture further comprises moving the proximal end and the distal endtoward each other.
 7. The method of claim 1, wherein pulling the suturefurther comprises increasing a diameter of the soft anchor.
 8. Themethod of claim 1, wherein pulling the suture further comprisesexpanding the soft anchor in a plane orthogonal to an insertiondirection.
 9. The method of claim 1, wherein the suture is held in placeby internal friction between the suture and at least one of the firstlocking element and the second locking element.
 10. The method of claim1, wherein the soft anchor is a single piece woven construction.
 11. Themethod of claim 1, wherein the soft anchor is absorbable.
 12. The methodof claim 1, wherein the soft anchor has an elongate shape in the firstinsertion state.
 13. The method of claim 1, wherein the soft anchor hasa cylindrical shape in the first insertion state.
 14. The method ofclaim 1, wherein the suture comprises a locking device.
 15. The methodof claim 1, wherein the suture comprises two segments and an arctherebetween, wherein the two segments are passed through the firstlocking element and around the second locking element.
 16. The method ofclaim 1, further comprising exerting a force on the first lockingelement and the second locking element when the suture is pulled.
 17. Amethod, comprising: positioning a soft anchor, the soft anchorcomprising: a body comprising a proximal end comprising an opening, adistal end, and a connecting portion extending therebetween; and a firstlocking element coupled to the body and a second locking element coupledto the body; and pulling a suture to cause the soft anchor to compressfrom a first insertion state to a second locking state, the suturepassed through the first locking element, around the second lockingelement, and through the first locking element, wherein at least one ofthe first locking element and the second locking elements is a ring. 18.A method, comprising: positioning a soft anchor relative to a bone, thesoft anchor comprising: a body comprising a proximal end comprising anopening, a distal end, and a connecting portion extending therebetween;a retaining portion disposed within the body, a first locking elementand a second locking element disposed around the retaining portion;pulling a suture to cause the soft anchor to collapse from a firstinsertion state to a second locking state, the suture passed through thefirst locking element, around the second locking element, and throughthe first locking element.